Ethmoidectomy – Procedures and complications

ABSTRACT
Ethmoid sinusitis is one of the most complicated pathologies in ear, nose, and throat (ENT) practice. Because of its anatomical particularities, ethmoid sinusitis can easily become a dangerous pathology, difficult to treat. The first method of treatment is usually proper medication, but sometimes it can be difficult to manage without surgery. Surgery may be performed, the most used being the intranasal (endoscopic) ethmoidectomy. Other types of surgical interventions are external ethmoidectomy and transantral ethmoidectomy. Each approach has advantages and disadvantages. The potential complications of endoscopic surgery are: orbital injury, blindness, orbital hematoma, epiphora, and postoperative epistaxis. Skull base injury and cerebrospinal fluid leak are very rare complications that should be discussed with patients undergoing endoscopic sinus surgery. Regardless of the approach used, the surgeon must be familiar with the anatomy and aware of all pertinent landmarks to reduce the risk of complications. Attention must be paid to avoid violating the cribriform plate or inadvertently entering the orbit.Key-words: ethmoid sinusitis, ethmoidectomy, orbital injury, external ethmoidectomy.

ANATOMICAL CONSIDERATIONS
The ethmoid sinuses develop during infancy and expand during the early childhood. The ethmoid sinuses are paired and they are divided into anterior and posterior ethmoid air cells. This division is provided by the basal lamella of the middle turbinate. The ethmoid sinus in adults has an average length of 4-5 cm and a height of approximately 3 cm1. The walls of the ethmoid sinus are composed of the maxillary, palatine, lacrimal, frontal and sphenoid bones. Medially to the sinus we find the lamina papyracea – the medial wall of the orbit and superior the fovea ethmoidalis. The ultimate pathway for the secretions from the anterior ethmoid air cells is the osteomeatal complex, in the middle meatus. The posterior air cells drain into the superior meatus. The infundibulum of the ethmoid represents a cleft that is demarcated by the uncinate process on its medial side and the lamina papyracea on its lateral side.

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